Systemic Lupus Erythematosus
Systemic lupus erythematosus (SLE) is an autoimmune disease. In this disease, the body’s immune system mistakenly attacks healthy tissue. It can affect the skin, joints, kidneys, brain, and other organs.
Causes
The cause of autoimmune diseases is not fully known. SLE is more common in women than men. It may occur at any age. However, it appears most often in people between the ages of 15 and 44. The disease affects African Americans and Asians more often than people from other races.
Certain drugs may also cause SLE.
Symptoms
Symptoms vary from person to person, and may come and go. Almost everyone with SLE has joint pain and swelling. Some develop arthritis. SLE often affects the joints of the fingers, hands, wrists, and knees.
Other common symptoms include:
Chest pain when taking a deep breath
Fatigue
Fever with no other cause
General discomfort, uneasiness, or ill feeling (malaise)
Hair loss.
Mouth sores
Sensitivity to sunlight
Skin rash: A “butterfly” rash in about half the people with SLE. The rash is most often seen over the cheeks and bridge of the nose. It can be widespread. It gets worse in sunlight.
Swollen lymph nodes.
Other symptoms depend on which part of the body is affected:
Brain and nervous system: Headaches, numbness, tingling, seizures, vision problems, and personality changes
Digestive tract: Abdominal pain, nausea, and vomiting
Heart: Abnormal heart rhythms (arrhythmias)
Lung: Coughing up blood and difficulty breathing
Skin: Patchy skin color and fingers that change color when cold (Raynaud phenomenon)
Kidney: Swelling in the legs, weight gain
Some people have only skin symptoms. This is called discoid lupus.
Exams and Tests
To be diagnosed with lupus, you must have 4 out of 11 common signs of the disease. Nearly all people with lupus have a positive test for antinuclear antibody (ANA). However, having a positive ANA alone does not mean you have lupus.
The health care provider will do a complete physical exam. You may have a rash, arthritis, or edema in the ankles. There may be an abnormal sound called a heart friction rub or pleural friction rub. Your provider will also do a nervous system exam.
Tests used to diagnose SLE may include:
Antinuclear antibody (ANA)
CBC with differential
Chest x-ray
Serum creatinine
Urinalysis
You may also have other tests to learn more about your condition. Some of these are:
Antinuclear antibody (ANA) panel
Complement components (C3 and C4)
Coombs test – direct
Cryoglobulins
ESR and CRP
Kidney function blood tests
Liver function blood tests
Rheumatoid factor
Antiphospholipid antibodies and lupus anticoagulant test
Kidney biopsy
Treatment
There is no cure for SLE. The goal of treatment is to control symptoms. Severe symptoms that involve the heart, lungs, kidneys, and other organs often need treatment from specialists.
Mild forms of the disease may be treated with:
NSAIDs for joint symptoms and pleurisy. Talk to your provider before taking these drugs.
Low doses of corticosteroids, such as prednisone, for skin and arthritis symptoms.
Corticosteroid creams for skin rashes.
Hydroxychloroquine, a drug also used to treat malaria.
Belimumab, a biologic drug, may be helpful in some people,
Treatments for more severe SLE may include:
High-dose corticosteroids.
Immunosuppressive drugs (drugs which dampen or suppress the immune system). These medicines are used if you do not get better with corticosteroids, or if your symptoms get worse when you stop taking them.
Blood thinners, such as Coumadin, for clotting disorders.
If you have SLE, it is also important to:
Wear protective clothing, sunglasses, and sunscreen when in the sun.
Get preventive heart care.
Stay up-to-date with immunizations.
Have tests to screen for thinning of the bones (osteoporosis).
Avoid tobacco and drink minimal amounts of alcohol.
